伴有非癫癎发作的322例脑性瘫痪临床分析

目的：了解伴有非癫癎发作的脑性瘫痪（脑瘫）的临床特点,以提高与癫癎发作的鉴别能力。方法：1 198例9个月至6岁的脑瘫患儿纳入研究,对伴随发作性症状的患儿进行24 h视频脑电图监测,明确伴随的发作是否为癫癎发作,并观察伴随非癫癎发作患儿的发作症状、年龄、脑瘫型别及脑电图特征。结果：共578例（48.24%）患儿伴随发作性症状,其中伴随癫癎发作者231例（19.28%）,非癫癎发作322例（26.88%）。322例伴随非癫癎发作的脑瘫患儿中,发作性症状包括非癫癎性强直发作、发作性摇头、耸肩或头后仰、发作性哭闹、惊恐发作、睡眠肌阵挛、刻板性运动等;158例（49.1%）显示脑电图有非特异性异常;111例（34.5%）在基层医院误诊为癫癎;1岁以内患儿非癫癎发作频率高于1岁~和3~6岁组患儿;痉挛型脑瘫患儿非癫癎发作频率最高（168例,52.2%）,其次为不随意运动型（69例,21.4%）和混合型(65例,20.2%)。结论：脑瘫患儿伴随的发作性症状部分为非癫癎发作,注意与癫癎发作相鉴别。非癫癎发作发生频率与患儿年龄及脑瘫型别有一定关系。［中国当代儿科杂志,2010,12(12)：933-935］     

脑性瘫痪致病因素及诊断探讨

为探讨脑性瘫痪的因素及诊断问题。回顾性分析了50例脑瘫患儿围产期病史,详细的临床评估、影像学及电生理检查,并征询家长对康复治疗意见,结果显示脑瘫以早产、低出生体重、围产期窒息为主要致病因素。脑瘫以痉挛性类型为主,尤以四肢瘫为多且重;脑瘫合并语言发育障碍44%,智力迟缓32%,听力异常18%,视力异常16%,癫痫16%;CT或MRI检查68%异常;接受运动、针灸、作业及语言治疗的依从性分别为86%、68%、46%、100%。提示建立多科联合对高危新生儿的监护和随访甚为重要;全面熟悉小儿发育知识,神经反射及Vojta姿式反射,增强康复观念,有助于脑瘫的早期诊断和干预;此外,还应加强全面康复的科普宣传。     

Twins and cerebral palsy

In a national follow-up study of twin births, monozygous compared with dizygous twins were at significantly increased for both to die in utero , one to die in utero and the co-twin to die in infancy, or both to be livebirths but both die in infancy. The prevalence of cerebral palsy among survivors of a co-twin fetal death was 80.2 and other cerebral impairment was 107.0 per 1000. Many apparently singleton cases of cerebral palsy and impairment may be due to fetal death of a twin that has not been recognized or has been recognized but not registered.     

脑性瘫痪动物模型的研究进展

脑性瘫痪（脑瘫）是导致儿童严重慢性残疾的重要原因。应用动物模型的目的是在动物身上复制一种或更多的脑瘫特征来进行研究,而这些模型和疾患本身一样是具有异质性的,如损伤发作的时间和机制（中风、感染、先天畸形或窒息）、损伤的靶点（白质或神经元）或功能结果等。该文对不同的脑瘫动物模型作一综述。     

Jerky spontaneous movements at term age in preterm infants who later developed cerebral palsy

Background

Assessment of spontaneous movements in infants has been a powerful predictor of cerebral palsy (CP). Recent advancements on computer-based video analysis can provide detailed information about the properties of spontaneous movements.

Aims

The aim of this study was to investigate the relationship between spontaneous movements of the 4 limbs at term age and the development of CP at 3 years of age by using a computer-based video analysis system.

Study design and subjects

We analyzed video recordings of spontaneous movements at 36–44 weeks postmenstrual age (PMA) for 145 preterm infants who were born preterm (22–36 weeks PMA with birthweights of 460–1498 g). Sixteen of the infants developed CP by 3 years of age, while 129 developed normally. We compared 6 movement indices calculated from 2-dimensional trajectories of all limbs between the 2 groups.

Results

We found that the indices of jerkiness were higher in the CP group than in the normal group (p < 0.1 for arms and p < 0.01 for legs). No decline was observed in the average velocity and number of movement units in the CP group compared with to the normal group.

Conclusions

Jerkiness of spontaneous movements at term age provides additional information for predicting CP in infants born preterm.     

Epilepsy in children with cerebral palsy

This article deals with the clinical profile of children with cerebral palsy and epilepsy, and to study the clinical predictors of response to anti-epileptic drugs. It is a prospective hospital based follow-up study. All the children who presented with cerebral palsy and history of seizure (other than neonatal seizures) over a period of one year were included. Seizures were classified according to ILAE classification. An EEG was obtained in all cases. Neuroimaging was done in all patients. Eighty-five patients were studied and followed for minimum of 12 months. Perinatal factors accounted for 62 (72.3%) cases. The motor deficits seen were quadriparesis (n = 64), hemiplegia (n = 12) and diplegia (n = 9). Associated mental retardation was seen in 80.9% patients with quadriparesis. A predominance of generalised epilepsy was seen with generalised tonic clonic seizures (32.9%) followed by mycolonic seizures (30.6%) and localisation related epilepsy (24.7%). The patients with quadriparesis were more likely to have generalised epilepsy and 52.4% of them required two or more anti-epileptic drugs for control of seizures. Patients with hemiplegia had localisation related epilepsy in 83.3% of cases. On multivariate analysis presence of quadriparesis, microcephaly, mental retardation and myoclonic epilepsy were found to predict the poor response to AED. Epilepsy in patients with cerebral palsy is of severe nature and difficult to control. Presence of quadriparesis, mental retardation and myoclonic seizures was predictive of poor response to anti- epileptic drugs.     

河南省儿童脑性瘫痪流行病学调查分析

目的 调查河南省0～6岁儿童脑性瘫痪(CP)的患病率、临床类型、相关病因及合并症的状况。方法 2001年1～12月,采用随机整群抽样方法,对河南省郑州市(金水区、二七区、邙山区)、洛阳市涧西区、济源市、原阳县、新野县、唐河县、太康县、虞城县10个市、区、县1995年1月1日至2000年12月31日出生的0～6岁儿童进行了调查。应用SPSS 10.0软件,进行统计学分析。结果 共调查0～6岁儿童434920人,男231111人,女203809人,男:女=1.13:1;发现CP患儿582例,男374例,女208例,男:女=1.80:1;患病率1.07‰～2.38‰,平均患病率为1.58‰。CP的各种类型中,痉挛型最多见,为331例(56.9％),肌张力低下型123例(21.1％),混合型44例(7.6％),强直型39例(6.7％),共济失调型31例(5.3％),震颤型8例(1.4％),手足徐动型6例(1.0％)CP的病因学调查中,以出生时窒息及缺氧缺血性脑病为多见,占38.3％(223例),双胎20.1％(117例),早产和(或)低体重16.8％(98例),母孕早期感染11.9％(69例),脑出血9.3％(54例)。以上均是引起CP的明显相关因素(与健康儿童组对比,均产<0.05),而新生儿期高胆红素血症、感染及胎粪吸入等,与CP的发生无明显相关性(P>0.05)。CT或MRI检查异常率70.0％(297/424例)。有合并症者占67.8％(394例),合并智力低下者49.0％(285例),语     

Diverticulosis of the urinary bladder in a child with cerebral palsy

Urological abnormalities are not usually encountered in children with cerebral palsy (CP), although there may be functional bladder problems. We report a case of bladder diverticulosis in a 2-year old female with CP who presented with a suprapubic mass. Bladder diverticulosis itself is a very rare abnormality.     

Epidemiology of cerebral palsy

The term cerebral palsy refers to a range of clinical symptoms, with related service requirements, resulting from lesions or abnormalities in the brain arising early in life. It is not a diagnosis; aetiology and pathology are variable. This article discusses the definition and differential classification of cerebral palsy, describes trends in its frequency over time stratified by associated variables, and briefly reviews the most recent findings concerning its aetiology.